飞秒微透镜边缘阶梯对视觉质量的影响

目的探讨全飞秒微透镜切除术后，光学切削过渡区的“无修边”设计是否影响患者术后视觉质量，特别是瞳孔散大超过光学切削区时。方法前瞻性队列研究。纳入患者共104例（208眼），其中薄瓣LASIK组38例（76眼）、飞秒LASIK组28例（56眼）、飞秒激光微小切口透镜切除术（SMILE）组 38例（76眼）。薄瓣LASIK组应用准分子激光切削，光学切削区直径6.0 mm，过渡区宽度1.25 mm，总直径8.5 mm；飞秒LASIK组应用飞秒激光制瓣，准分子激光切削，光学切削区直径6.0 mm，过渡区宽度1.25 mm，总直径8.5 mm；SMILE组应用飞秒激光完成微透镜切除，透镜直径设定6.0 mm。术后检查裸眼视力、小瞳（≤5 mm）及大瞳（≥7 mm）的对比敏感度（CS）与眩光敏感度（GS）、波前像差。采用单因素方差分析对数据进行比较。结果术中及术后均无严重并发症发生，术眼裸眼视力3组均达到或超过术前最佳矫正视力。在小瞳（≤5 mm）下，3组患者在各空间频率，无眩光刺激和有眩光刺激下的视觉对比敏感度差异均无统计学意义。在大瞳（≥7 mm）下，3组患者在各空间频率，无眩光刺激和有眩光刺激的视觉对比敏感度差异均无统计学意义。小瞳（≤5 mm）时3组C12比较差异无统计学意义，而大瞳（≥7 mm）时薄瓣LASIK组与飞秒LASIK组比较差异无统计学意义，SMILE组与薄瓣LASIK组、飞秒LASIK组分别比较，差异具有统计学意义（t=2.942，P<0.01；t=3.264，P<0.01）。SMILE组C12值（0.422±0.123）均小于薄瓣LASIK（0.577±0.147）与飞秒LASIK组（0.606±0.158）。结论与设定了过渡区“修边”的薄瓣LASIK组、飞秒LASIK组相比，SMILE组手术的无光学过渡区修边设计对患者术后视觉质量无明显影响。

Effects of a femtosecond microlens edge ladder design on visual acuity outcomes

Objective To analyze the effect of a ＆quot;no trim＆quot; design in the optical ablation zone on postoperative visual quality in patients who have undergonc femtosecond microlens rescction surgery,especially with dilated pupils.Methods This was a prospective cohort study.Postoperative visual quality was measured in 3 groups of patients （a total of 104 cases,208 eyes） that included a thin flap LASIK group （38 patients,76 eyes）,a femtosecond LASIK group （28 patients,56 eyes） and a femtosecond laser surgery small incision lens （SMILE） group （38 patients,76 eyes）.Excimer laser cutting equipment was used in the thin flap LASIK group,optical zoom was 6.0 mm,transition zone was 1.25 mm; femtosecond laser was used for the corneal flap in the femtosecond LASIK group,optical zoom was 6.0 mm,transition zone was 1.25 mm; and femtosecond laser was used in the SMILE group for refractive microlens （6.0 mm） fabrication.Postoperative assessments included uncorrected visual acuity,contrast sensitivity （CS）,glare sensitivity （GS） and wavefront aberration measurements for normal （≤5 mm） and dilated （≥7 mm） pupils.SPSS 15.0 statistical software was used for statistical analysis.Distribution normality was tested （-x＆#177;s）,and then one-way ANOVA was used for overall analysis.After multiple group comparisons,differences between groups were tested with pairwise t-test comparisons.Test results were considered statistically significant at P〈0.05.Results No serious intraoperative or postoperative complications were found in the three groups.Postoperative vision with a dilated pupil reached or was higher than preoperative best corrected visual acuity.With normal pupils （5 mm or less）,no statistically significant differences were found in visual contrast sensitivity among the three groups with or without glare stimulation.Also with dilated pupils （7 mm or larger）,no statistically significant differences were found with or without glare.There were no statistically significant differences among the three groups for waveform spherical aberration C12 under normal pupil conditions.Whereas with dilated pupils,there were no statistically significant differences between the thin fcmtosecond LASIK and flap LASIK groups.But there were significant differences when the SMILE group was compared with the thin flap LASIK group and femtosecond LASIK group （t=2.942,P〈0.01; t=3.264,P〈0.01）.The C12 values of the SMILE group （0.422±0.123） were smaller than the thin flap LASIK group （0.577±0.147） and femtosecond LASIK group （0.606±0.158） under both pupil conditions.Conclusion Compared with “trim” thin flap LASIK and femtosecond LASIK that involved a transition region,full femtosecond microlens removal without an optical ablation zone trim design had no obvious effect on postoperative visual quality.